MAUDE Adverse Event Report: B. BRAUN MELSUNGEN AG INTROCAN SAFETY; I.V. SAFETY CATHETER

Catalog Number UNKNOWN INTROCAN

Device Problems Positioning Failure (1158); Activation, Positioning or Separation Problem (2906)

Patient Problem No Consequences Or Impact To Patient (2199)

Event Date 12/25/2014

Event Type  malfunction  

Event Description

As reported by the user facility: introcan, product # unk, lot # unk, date of occurrence: (b)(6) 2014.Event: needlestick injury; ".Nurse incurred a needle stick on today because the safety mechanism did not cover the needle properly upon withdrawal as it is designed to do.".

Manufacturer Narrative

(b)(4).Without the actual sample, catalog item or lot number, a thorough investigation could not be performed and no specific conclusion can be drawn.All available information has been provided to the actual manufacturer, b.Braun (b)(4).If the sample and/or additional pertinent information becomes available, a follow up report will be filed.(b)(4).

• Brand Name: INTROCAN SAFETY
• Type of Device: I.V. SAFETY CATHETER
• Manufacturer (Section D): B. BRAUN MELSUNGEN AG; carl-braun str. 1; melsungen 3421 2; GM 34212
• Manufacturer Contact: ludwig schuetz ; carl-braun-str. 1; melsungen ; GM ; 661712769
• MDR Report Key: 4341001
• MDR Text Key: 21339818
• Report Number: 9610825-2014-00449
• Device Sequence Number: 1
• Product Code: FOZ
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: K982805
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Health Professional,User Facility
• Reporter Occupation: Other Health Care Professional
• Remedial Action: Other
• Type of Report: Initial
• Report Date: 12/05/2014,11/25/2014

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 12/05/2014
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Catalogue Number: UNKNOWN INTROCAN
• Device Lot Number: UNKNOWN
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Was the Report Sent to FDA?: Yes
• Date Report Sent to FDA: 12/05/2014
• Distributor Facility Aware Date: 11/21/2014
• Event Location: Hospital
• Date Report to Manufacturer: 12/05/2014
• Date Manufacturer Received: 11/21/2014
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial
• Patient Sequence Number: 1